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141. COVID-19 - paediatric scenarios

. Following transfer, the room should be chlorine cleaned. Special cases: children with febrile neutropenia and suspected COVID-19 Children should initially be assessed and tested in ED not the wards. Prompt administration of broad-spectrum antibiotics for the management of febrile neutropenia is essential. In the Oncology wards may wish to designate specific cubicles for patients with suspected COVID-19. All infectious disease precautions must be followed as for other COVID-19 patients as well

2020 Royal College of Paediatrics and Child Health

142. COVID-19 - guidance for acute settings

for the . It outlines key principles for the medical management of children admitted to hospital with COVID-19, including: Radiology Fluids Antipyretics Respiratory support Antibiotics Antivirals Bronchodilators and treatment of children with asthma attacks Systemic steroids Liver dysfunction Hydroxychloroquine This guidance is based on literature review of published and unpublished data, expert opinion, and national/international guidelines, and is subject to updates as evidence becomes available. Discharging

2020 Royal College of Paediatrics and Child Health

143. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children

countries and the UK in this decreasing phase of the epidemic. It is possible that more cases will be recognised as more countries enter this phase and more publicity is given to this syndrome. Clinical management Based on information from the reporting countries, management of PIMS-TS cases has been mostly supportive as they are at the severe end of the spectrum. As KD was part of the differential diagnosis, treatment with IVIG has been the predominant management option. Antibiotics, corticosteroids

2020 ICM Anaesthesia COVID-19

144. Chronic obstructive pulmonary disease (COPD)

Workshops 5 Pharmacologic Treatment 6 Bronchodilator therapy 6 Medication guide 7 Oxygen therapy 7 Treatments that are not recommended 8 COPD Exacerbations 9 Treatment of COPD exacerbations 10 Prophylactic antibiotics for exacerbation prevention 11 Follow-up and Monitoring 12 Medication monitoring 12 Long-term steroid use and osteoporosis risk 12 Immunizations 12 Referral 13 Evidence Summary 14 References 16 Guideline Development Process and Team 18 Appendix 1. COPD Assessment Test (CAT). 19 Appendix 2 (...) symptom (increased dyspnea or increased sputum volume) is required for an exacerbation diagnosis. A chest X-ray is recommended for all patients with a suspected COPD exacerbation. Severity of exacerbation ? Mild exacerbation: the person has an increased need for short acting bronchodilators, which they can manage in their own normal environment. ? Moderate exacerbation: the person has a sustained worsening of respiratory status that requires treatment with systemic corticosteroids and/or antibiotics

2020 Kaiser Permanente Clinical Guidelines

145. Covid-19: Management of palliative care in hospital during the coronavirus pandemic

not already exist. NHS England and NHS Improvement Goals of care The treatment of patients suffering from coronavirus may be orientated towards: • • • Supportive measures – for example, provision of fluids and/or oxygen. Targeted treatment – for example, provision of antibiotics to treat pneumonia. Organ support – for example, ventilator support, renal replacement therapy, etc. These are aimed at preserving and prolonging life. It is important to remember that most people with coronavirus will survive (...) supportive treatments and management of their comorbidities has been optimised. The good practice approach to symptom management is as follows: • Correct the correctable, for example, give the patient antibiotics for a bacterial infection. • Non-drug approaches, especially in mild to moderate disease – see Appendix 1. 3 | Clinical guide for the management of palliative care in secondary care during the coronavirus pandemic, Version 1 • Drug approaches – see Appendix 1. The most common symptoms

2020 Covid-19 Ad hoc guidelines

146. Clinical guide for the management of respiratory patients during the coronavirus pandemic

physicians have support and training in helping deliver some routine respiratory care. This could be facilitated by deploying hospital-based nurses to support colleagues. Ambulatory care and management of pleural disease • Maximise ambulatory care options to allow safe discharge from A&E/MAU of appropriate cases • Use home intravenous antibiotic services where available • Move to a day case, ambulatory care model for pleural disease • Agree local pathways for pleural disease that can be used for urgent (...) admission avoidance • There should be a clean day case area for patients to attend for pleural procedures, administration of biologics for asthma, insertion of lines and test dose of antibiotics for CF 3 | Clinical guide for the management of respiratory patients during the coronavirus pandemic Outpatient clinics GIRFT has produced a virtual working guide as part of this series of Specialty guides: www.england.nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/ • The majority

2020 Covid-19 Ad hoc guidelines

147. Information for adult patients with immune thrombocytopenia in the setting of COVID-19 pandemic

Cyclosporine Vincristine Rituximab (given in the past 12 months) Splenectomy (patients are advised to be diligent with their antibiotic prophylaxis and be up- to-date with their vaccination schedule) Neither Romiplostim (N-Plate) nor Eltrombopag (Revolade) will affect the immune system and risk will depend on other treatments being received at the same time or in the recent past. Any change in ITP medication should be discussed with your ITP centre and should NOT be discontinued unless advised. If you

2020 Covid-19 Ad hoc guidelines

148. Haemoglobinopathy HCCs response to Covid-19

. If they present out of hours the patient or the admitting medical/haematology teams should be encouraged to contact the haemoglobinopathy teams. If self-isolating they should be given additional antibiotics, phone follow up should be arranged and they should be asked to present if they have worsening symptoms. Red flag symptoms: Patients should be encouraged to attend the Emergency Department (A+E) or call 999 if any of the following occur: ? Uncontrolled pain >7/10 despite usual home analgesia ? Respiratory

2020 Covid-19 Ad hoc guidelines

149. Clinical care of severe acute respiratory infections – Tool kit

transportation 64 5.8 Guideline for specimen transportation 65 5.9 Guide for blood culture collection 66 6. OXYGEN THERAPY 67 Summary 68 References and resources 69 6.1 Algorithm to deliver increasing oxygen in adults 70 6.2 Algorithm to deliver increasing oxygen in children 71 6.3 Checklist to troubleshoot warning signs during oxygen delivery 73 6.4 Algorithm to escalate supportive respiratory therapy 74 7. ANTIMICROBIAL THERAPY 75 Summary 76 References and resources 77 7.1 Anti-COVID-19 therapeutics 79 7.2 (...) Pneumonia severity and empiric antimicrobial therapy 80 7.3 Oseltamivir notice 82 8. SEPSIS AND SEPTIC SHOCK 85 Summary 86 References and resources 87 8.1 Sepsis definitions 89 8.2 Targeted resuscitation in adults in an ICU setting 90 8.3 Initial resuscitation, fluid and vasoactive-inotrope management algorithm for children with septic shock 91 8.4 Guide to the use of vasopressors in septic shock for adults and children 93 8.5 Passive leg raise 94 Clinical Care for Severe Acute Respiratory Infection

2020 WHO Coronavirus disease (COVID-19) Pandemic

150. Water, sanitation, hygiene and waste management for COVID-19

solution, mixing detergent with water can be used j . The ratio of detergent to water will depend on types and strengths of locally available product. 39 Soap does not need to be antibacterial and evidence indicates that normal soap is effective in inactivating enveloped viruses, such as coronaviruses. 40,41 Alcohol-based hand rub should contain at least 60% alcohol. Such products should be certified and, where supplies are limited or prohibitively expensive, can be produced locally according to WHO (...) , Yeasmin D, Akhter S, et al. Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh. The American journal of tropical medicine and hygiene. 2017;96(2):421-9. doi: 10.4269/ajtmh.16-0304. 40. Montville R, Schaffner DW. A meta-analysis of the published literature on the effectiveness of antimicrobial soaps. J Food Prot. 2011;74(11):1875-82. doi: 10.4315/0362-028X.JFP-11-122. 41. Sickbert-Bennett EE, Weber DJ, Gergen-Teague

2020 WHO Coronavirus disease (COVID-19) Pandemic

151. Covid-19: Management of emergency department patients

presentations not requiring admission: (taken from same day emergency care (SDEC) guidelines, documents and expert advice from national clinical directors) Expect not to admit overnight the following: Clinical specialty Emergencies that do not require admission Respiratory Pneumonia/COPD without oxygen /NIV requirement. May need initial antibiotics and assessment of response (yet may not require an overnight stay). Asthmatic with PEFR > 75% best or predicted PE without physiological compromise CNS Stroke (...) with clinical decision for oral antibiotic or SDEC i.v. Toxicology Overdose patients with non -toxic levels or asymptomatic 6-12 hrs after ingestion (guided by ToxBase) Other Patients on an end of life pathway or for whom ceiling of care does not require hospitalisation All patients in the above groups who are not admitted must receive appropriate follow up, wherever possible by telephone/video call etc. Advice for patients with flu like symptoms who are not being admitted PHE has published clear guidelines

2020 Covid-19 Ad hoc guidelines

153. Management of Tick Bites and Lyme Disease During Pregnancy

with a tick bite or suspected Lyme disease should be managed similarly to non-pregnant adults, including the consideration of antibiotics for prophylaxis and treatment. The primary objective of this committee opinion is to inform practitioners about Lyme disease and provide an approach to managing the care of pregnant women who may have been infected via a blacklegged tick bite. Intended users Health care providers who care for pregnant women or women of reproductive age. Target population Women (...) series. BMC Infect Dis. 2009; 9 : 79 Warshafsky S Lee DH Francois LK et al. Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis. J Antimicrob Chemother. 2010; 65 : 1137-1144 Cross R Ling C Day NP et al. Revisiting doxycycline in pregnancy and early childhood–time to rebuild its reputation?. Expert Opin Drug Saf. 2016; 15 : 367-382 National Institute for Health and Care Excellence (NICE) Lyme disease (NG95). NICE , London, United

2020 Society of Obstetricians and Gynaecologists of Canada

154. The acute management of paediatric coronavirus disease 2019 (COVID-19)

[ ] [ ] . In cases of severe disease, additional pressure and ventilatory support may be required, including intubation [ ] . To optimize first-pass success, intubation should be performed by the most experienced provider, with the fewest possible number of health care providers exposed in the room. Antibiotics are not recommended to treat cases of COVID-19 without clinical suspicion of bacterial co-infection. Early studies in China found the rate of secondary bacterial infection to be low. However, when (...) there is evidence for a secondary infection, appropriate antibiotics should be administered pre-emptively, without waiting for confirmatory test results. For sepsis, treat with an IV third-generation cephalosporin, such as cefotaxime (50 mg/kg/dose every 6 h, to a maximum 2 g/dose or 8 g/day), or IV ceftriaxone (75 mg/kg/dose every 12 to 24 h, to a maximum 4 g/day), with the addition of IV vancomycin (15 mg/kg/dose every 6 h, to a maximum 500 mg/dose) for severe disease. For pneumonia, first-line treatment

2020 Canadian Paediatric Society

155. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases: interim guidance

* For transport of samples for viral detection, use viral transport medium (VTM) containing antifungal and antibiotic supplements. Avoid repeated freezing and thawing of specimens. If VTM is not available sterile saline may be used instead (in which case, duration of sample storage at 2-8 °C may be different from what is indicated above). Aside from specific collection materials indicated in the table also assure other materials and equipment are available: e.g. transport containers and specimen collection

2020 WHO Coronavirus disease (COVID-19) Pandemic

156. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

, the nurse should analyze the cause comprehensively andbe vigilantto notify thedoctor. 8.2.2 Nursing of medication Mild patients generally use antiviral drugs, antibacterial drugs (when bacterial infection exists), and symptomatic treatment. The doctor’s advice should be followed accur- ately and timely. The adverse reactions of oseltamivir mainly include nausea, vomiting, diarrhea, abdominal pain and bronchitis, cough, etc. The adverse reactions of inter- feron are mainly flu-like symptoms such as fever

2020 Covid-19 Ad hoc guidelines

157. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

with Staphylococcus aureus is common with in?uenza pneumonia and can be especially virulent [154]. Recent clinical practice guidelines recommend initiating empiric antibacterial therapy in adults with community-acquired pneumonia who test positive for in?uenza [154]. Data from critically ill patients demonstrate secondary infection in about 11% of cases, although the numbers are small. Isolated organisms included gram-negative Intensive Care Medicine GUIDELINES Un-edited accepted proof* © European Society (...) of Intensive Care Medicine and the Society of Critical Care Medicine 2020 31 organisms such as K. pneumoniae, P. aeruganosa, and S. marcescens. On the basis of these limited data it is difficult to determine patterns of superinfection, including the risk of S. aureus infection, commonly seen in influenza. In patients with COVID-19 and hypoxic respiratory failure requiring mechanical ventilation, the panel suggest empiric antimicrobial treatment, on the basis that superinfection is reasonably common

2020 Covid-19 Ad hoc guidelines

159. Critical Care Preparation and Management in the COVID-19 Pandemic

dose (MAC 0.2-0.5) inhalational anaesthesia may be used to maintain sedation with a volatile agent in a low-flow (circle) system. Ventilation Ensure use of an antimicrobial filter within the circuit or placed on the expiratory limb or ventilator exhaust. Note that filters represent an airflow obstruction risk when saturated and routine exchange is advised. Use in-line suction catheters where possible. Avoid inadvertent ventilator circuit disconnections by ensuring all connections are 'tight (...) .' Manual ventilation, or 'hand-bagging' is not advised. Ensure the endotracheal tube is clamped during any planned circuit disconnection, eg switching between ventilators, replacing the antimicrobial filter, or inserting a bronchoscope into the tube. Management of Acute respiratory distress syndrome (ARDS) Follow including: lung protective ventilation conservative fluid management strategy neuromuscular blockade lung recruiting manoeuvres and ventilator modes (eg APRV). Further information from

2020 ICM Anaesthesia COVID-19

160. Covid-19: National supporting guidance for Scottish General Practice

be considered for review by the practice: ? Routine bloods ? Routine BPs ? Other routine work ? Medication Reviews ? Long term condition/ Chronic Disease Reviews ? Review of Enhanced Services eg Minor Surgery, Diabetes etc ? Review all Private Work – routine medical reports, ESA, PIP forms, Insurance medical forms, HGV medicals etc ? Review all Subject Access Requests ? Lower threshold to issue acute medicines on request rather than make contact with patient ? Lower threshold for antibiotic prescribing (...) /watching TV, less concerning than lying in bed not wanting to do anything at all). FEVER/COUGH/SHORTNESS of BREATH/UNWELL: • Use the NHS24 COVID-19 Assessment Tool (see below) COVID 19 GP Assessment Tool V1.0.pdf COVID 19 Self Care V0.6.pdf • Remember, some patients have BP machines and pulse oximeters at home - ask. What is normal for them? • Assess whether they need hospitalisation. If symptoms of pneumonia (green/yellow sputum) prescribe antibiotics. If not send them the COVID-19 Self Care document

2020 Covid-19 Ad hoc guidelines

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